Education

* indicates required field

How did you hear about us? *

Contact Name *

Contact Email *

Contact Phone *( ) -

Name of Requesting College and/or Group *

Date Requested *Now

Time Slot Requested *

Are you able to provide equipment to play a DVD and a PowerPoint Presentation? *

Have any incidences prompted a call to The Gordie Foundation? *

If Yes, Please Explain

Physical Address *

City *

State *

Zip Code *

Description *

Audience Type *

Other

Number of Attendees *

Estimated Average Age of Attendee *

Cost: $2,500 donation (speaking fee) made payable to The Gordie Foundation

We thank you for your request and look forward to working with you to spread awareness about the dangers of alcohol, binge drinking and hazing.